N=1: What can we learn from a case report

In medicine a case report is when a detailed description of a patient is published because something can be learnt from this one case. Case reports are a kind of evidence that must be scrutinized carefully because ultimately it’s just an N of 1 (only one person in the study). But on occasion they can be a striking piece of evidence.

The case study of Phineas Gage is a classic example. Phineas had the frontal lobe of his brain removed by an accident involving a metal rod, propelled by explosives, flying through his head. He went from a nice responsible person to a difficult individual with a gambling problem. Because it’s extremely unlikely that Phineas Gage uses his brain differently to the rest of us, we learnt that the frontal lobe is important in social understanding and risk management.

In this blog I’m going to do a case report, but not of a medical case, of a criminal case involving two sexual predators, and I will argue that we can learn (or re-learn) a lot from this case report.

We fail to trust and support victims of sexual assaults. During any public case involving sexual assault there is a chorus of distrust of the victims by a fair proportion of the vocal population; particularly if the victim is reporting an assault from several years ago. Just see the latest conservative op-edsor even any comment thread relating to the accusations leveled at Supreme Court Judge nominee Brett Kavanaugh, actually forget comment threads and just look at the President of the United States of America. A large proportion of the population think sexual assault is a rare event and think it unlikely that any upstanding male individual who went to university would do such a thing. They are victim deniers.

Consistent victim deniers are very similar to climate change deniers, they ignore the evidence. Study after study has shown that sexual assaults occur in unfathomable frequency, the majority of which go unreported. Several studies have found that around 1 in 5 to 1 in 10, female college students are sexually assaulted during their time at university (reviewed here). However, this statistic is not widely trusted. Conservative commentators are often very critical of these studies; they write pieces attacking the research by feeding the slut shaming narrative or polarizing politicizing rhetoric that is attractive to modest conservative audiences. Like Glenn Harlan Reynolds from USA today writing ..”the current moral panic over campus rape seems more like political agitprop and mass hysteria than anything else” . Victim deniers ask things to the effect of -why haven’t all these women press charges?, why didn’t they report this at the time of the incident?, or claim that these women just regret their decision to have consensual sexual encounters – like Naomi Schaefer Riley who wrote “…there’s been no epidemic of assault but instead a preponderance of sexual encounters fueled by bad judgment and free-flowing alcohol”.

The truth is that the prevalence of sexual assault are undoubtedly as high as 1 in 10. Victims don’t come forward partly because convictions are incredibly rare -41,150 rapes were reported in England and Wales in 2016-17 but only 2,991 people were convicted of the crime (reported here)- and partly because of personal reasons that we have no right to judge, such as not wanting to re-live the experience and not wanting the label of “victim”.

Now for those who are victim deniers and doubt the numerous studies that provide strong evidence for the indefensible-horrific-disgusting rates of sexual assault, there is now an salient case report that completely confirms what victims, scientists and feminists have been saying. Grant William Robicheaux, 38, and Cerissa Laura Riley, 31, have been charged with two separate sexual assaults on two women in 2016.

They are accused of getting the victims drunk, drugging them, and then raping them. This is horrible. But it gets worse. When the police raided their home they found, guns, date rape drugs, and, their cell phone and computer. And on their cell phone and computer the police report finding thousands of videos taken by Grant William Robicheaux and Cerissa Laura Riley of them performing nearly identical sexual assaults (reported here).

The women in these thousands of videos “appear to be highly intoxicated beyond the ability to consent or resist, and they’re barely responsive to the defendant’s sexual advances” -District Attorney Tony Rackauckas; adding that there are likely “hundreds” of victims who have not come forward. Silent victims.

This case has, in my opinion, definitive proof of hundreds of sexual assaults of which only two women came forward. This is as close to an experiment of sexual assault reporting as you could get. Hundreds of women were raped with irrefutable evidence (in my opinion) and only two reported the incident. In this case less than 98% of sexual assault victims didn’t report the crime. Survey studies suggest the rates are around 90% of case unreported. Think about this in the context of the 41,150 rapes which were reported in England and Wales last year.

This case study completely supports the survey based studies which suggest that 1 in 5 (to 10) women have been sexually assaulted of which a minority ~2-10% are reported. Like the case study of Phinaes Gage, we have no reason to believe that the case study of Grant William Robicheaux and Cerissa Laura Riley’s victims is abnormal. The vast majority of sexual assaults are not reported and no conviction occurs in vast majority of reported sexual assaults. People (mostly women) are being sexually assaulted at disgusting rates and only a fraction of a fraction of the men perpetrating these crimes are ever brought to justice.

The case study of Grant William Robicheaux and Cerissa Laura Riley’ flies in the face of any victim doubters. Anyone who claims the statistics are cooked. Anyone who thinks like Glenn Harlan Reynolds claiming the sexual assault epidemic is just “mass hysteria than anything else” (if you don’t already, you should hate the word “hysteria”… and Glenn Harlan Reynolds). There are millions of silent victims out there. When they come forward, believe them. When they come forward, support them. When they come forward stand with them. Because each of these women is just the tip of an atrocious iceberg, they represent dozens of other silent victims they likely never met.

A quote, perhaps wrongly attributed to Stalin goes “The death of one man: that is a catastrophe. One hundred thousand deaths: that is a statistic!”. If what I’ve written feels like a cold uncatastrophic statistics, then listen to this one women’s story , and believe her – Dr. Christine Blasey Ford

References

Abbey A (2002) Alcohol-Related Sexual Assault: A Common Problem among College Students. Journal of studies on alcohol Supplement (14):118-128

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